Utilizing In Vivo and Imaginal Exposure in the Context of MDMA-Assisted Therapy for Social Anxiety Disorder: A Case Report
Jason B. Luoma, M. Kati Lear, Kyong Yi, Brian Pilecki
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Randomized |
|---|---|
| Sample size | 1 |
| Population | Man in his late 30s with generalized social anxiety disorder |
| Interventions | MDMA-assisted therapy imaginal exposure in vivo exposure imagery rescripting social activation homework |
| Duration | Three non-drug preparation sessions, two drug sessions, and six non-drug integration sessions |
| Topics | Anxiety MDMA |
| Key findings | MDMA-assisted therapy incorporating imaginal and in vivo exposure techniques led to significant reduction in social anxiety symptoms and functional impairment in a participant with generalized SAD. |
Abstract
This case report describes the application of in vivo and imaginal exposure techniqueswithin MDMA-assisted therapy (MDMA-AT) for social anxiety disorder (SAD). The treatment,conducted as part of a randomized controlled trial, consisted of three non-drug preparationsessions, two drug sessions, and six non-drug integration sessions. Exposure interventionsincluded imaginal exposure to shame-related memories during MDMA sessions, in vivo socialexposures during MDMA sessions, imagery rescripting exercises during integration sessions, andsocial activation homework between sessions. The participant, a man in his late 30s withgeneralized SAD, showed significant reduction in symptoms and functional impairment asmeasured by the Leibowitz Social Anxiety Scale and Sheehan Disability Scale. Qualitativereports indicated increased social engagement, reduced anxiety in social situations, and a shifttowards more self-compassion. The participant found both imaginal and in vivo exposuresduring MDMA sessions particularly impactful, reporting they allowed him to access intrinsicdesires for social connection and performance that were previously masked by anxiety. This casesuggests MDMA-AT incorporating exposure techniques may be a promising treatment for SAD,warranting further research.
Comparable studies
Other case reports and case series on MDMA for anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Anxiety-related Symptoms following the Sporadic Use of Ecstasy – A Case Study High-functioning 24-year-old student with a history of obsessive-compulsive disorder... | 2021 | Case study | n = 1 |
| The treatment of abandonment anxiety with MDMA and LSD Young woman in her mid-twenties with abandonment-related anxiety | 2023 | Retrospective case study | n = 1 |
| MDMA, Internal Family Systems therapy, and the Minnesota model in the resolution of C-PTSD-induced alcohol and diazepam addiction—A retrospective case study Man in his forties with alcohol and diazepam addiction and complex PTSD from childhood... | 2023 | Case study | n = 1 |
| MDMA ("ecstasy") and panic disorder: induction by a single dose. One individual with no prior psychiatric history who ingested a single typical dose of... | 1992 | Case study | n = 1 |